Eye opening

Curing cataracts in the Himalayas and beyond

In the remote village where Geoff Tabin, MD, lived while working at a Nepalese hospital in the late 1980s, blindness was akin to a death sentence. “It was just accepted that you get old, your hair turns white, your eyes turn white, you go blind and you die,” he says.

Then, one day, a Dutch medical team arrived to perform cataract surgeries. “I had watched blind patients kind of shriveling up,” says Tabin, who joined Stanford in June as an ophthalmology professor. But the day after their cataract surgeries, “people came back to life,” he says. “It was amazing.”

Cataracts are cloudy or opaque areas in the lens of the eye that block light entry, and develop naturally with age. In developing countries, poor nutrition, injury, disease or exposure to unfiltered ultraviolet sunlight can speed up the clouding. Though cataracts can be treated by replacing the cloudy lens with a clear, soft, plastic implant, access to the surgery is limited and surgeons can be scarce in far-flung regions of the developing world.

Tabin’s passion for mountaineering — in 1990, he became the fourth person in the world to summit the highest peaks on all seven continents — had already sparked his interest in global medicine. Witnessing the profound impact of cataract surgery inspired him to combine that with ophthalmological training. After a residency at Brown University and a fellowship in corneal surgery in Melbourne, Australia, Tabin returned to Nepal in 1994.

There, he met Sanduk Ruit, MD, a Nepalese ophthalmologist devoted to reversing treatable blindness. Ruit became a mentor and friend to Tabin, and in 1995, the pair co-founded the Himalayan Cataract Project with the aim of providing access to high-quality eye care in Nepal.

At the time, 1 percent of the Nepalese population was blind. Cataracts caused 70 percent of unnecessary blindness, says Tabin, and there was an estimated backlog of 255,000 surgeries.

Blindness can have a serious impact in the developing world. When people become blind, their life expectancy drops to one-third that of their healthy peers. Ninety percent of blind people do not work, often because they are unable to navigate long distances or rugged terrain. Family members often forgo work or school to care for them.

Since the Himalayan Cataract Project’s founding, its doctors have performed over 600,000 surgeries in 16 countries. Thanks to Ruit’s surgical and lens-implant innovations, cataract replacement surgeries take 10 minutes and cost $25. Today, the blindness rate in Nepal is 0.24 percent, Tabin says, comparable to that of Western countries.

The Himalayan Cataract Project also trains local doctors and ophthalmological personnel as part of its mission to create self-sustaining eye-care systems in developing countries. Nepalese doctors now perform over 300,000 cataract surgeries annually, up from 15,000 per year before the project was founded. Himalayan Cataract Project training programs are thriving in other Asian countries, including Bhutan, Tibet, India and Myanmar.

Tabin and Ruit have now set their sights on sub-Saharan Africa. They’ll start with Ethiopia and Ghana, where Tabin has been developing training programs for the past eight years. “I’m really hoping that in the next 10 years we have the same success in reversing blindness in Africa that we’ve been able to accomplish in Asia,” he says.